Provider Demographics
NPI:1194598383
Name:PROTESTANT JOHN CALVIN MEDICAL CENTER
Entity type:Organization
Organization Name:PROTESTANT JOHN CALVIN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-352-1223
Mailing Address - Street 1:4220 W 3RD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3450
Mailing Address - Country:US
Mailing Address - Phone:213-352-1223
Mailing Address - Fax:213-487-0124
Practice Address - Street 1:4305 TORRANCE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4418
Practice Address - Country:US
Practice Address - Phone:310-710-7002
Practice Address - Fax:213-487-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty